Basic Information
| Provider Information | |||||||||
| NPI: | 1669636445 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | EMERGENCY ROOM CARE SC | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 87618 | ||||||||
| Address2: | DEPT 10166 | ||||||||
| City: | CHICAGO | ||||||||
| State: | IL | ||||||||
| PostalCode: | 606800618 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6308751500 | ||||||||
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| Practice Location | |||||||||
| Address1: | 4646 N MARINE DR | ||||||||
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| City: | CHICAGO | ||||||||
| State: | IL | ||||||||
| PostalCode: | 606405759 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7738788700 | ||||||||
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| ProviderEnumerationDate: | 07/11/2008 | ||||||||
| LastUpdateDate: | 07/11/2008 | ||||||||
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| AuthorizedOfficialLastName: | WAKIM | ||||||||
| AuthorizedOfficialFirstName: | PIERRE | ||||||||
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| AuthorizedOfficialTitleorPosition: | OWNER | ||||||||
| AuthorizedOfficialTelephone: | 6304728800 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | DO | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207P00000X | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Emergency Medicine |
No ID Information.